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The Job of Family Caregiving

Instead of paying someone else or transferring a senior loved one to a facility, wouldn’t it be much better if a family member gave them care at home? The family member can pay the bills, balance the checkbook, keep the house clean, shop and make meals, and take their aging parent on outings and to the doctor. The senior stays in familiar surroundings getting the care and attention they need, and the family member can even be paid, so they don’t give away their time and labor for free.

What Should Be Simple May Require Legal Guidance

The daughter, Jessica, quit her job to care for Ellen, her mother. But when Ellen fell and needed nursing-home care, the caregiving arrangement cost them nearly $70,000.00 in lost Medicaid benefits. This led to litigation.

The court was sympathetic but was still unable to help. The judge understood that Ellen might as well pay Jessica rather than a third party to provide companion services, especially because she is a member of the family and had Ellen’s best interests in mind. Nevertheless, the court ruled that Jessica failed to document her hours and services with a contract as the law requires. Without that proof, the court found that Jessica should have returned to work instead, where she would have earned more and could afford to hire an agency. Without the required proof, it appeared that mother and daughter had entered into the caregiving arrangement only to give money to Jessica.

Medicaid has Strict Rules Regarding Paid Caregiving Arrangements

The Medicaid rules penalize people for gift-giving, even in a case like Ellen’s. Money or property must not be given away during a five-year lookback period prior to the need for long-term care services. By breaking this rule, Ellen no longer had Medicaid benefits to pay for the extremely high cost of nursing home care.

Other Complications in Family Caregiver Situations

Even if Jessica had treated caregiving like any other job, and if she had documented her work as the law requires with a signed caregiver contract specifying working hours and services provided, and logged her hours as the law also requires – payment under a caregiver agreement must also be reported to the IRS for income tax purposes, or risk stiff penalties.

There is also a risk that a caregiver could be injured on the job. Worker’s compensation insurance would be a good idea.

Consulting and Elder Law Attorney

How a family caregiver is paid is important. It may not be possible for them to receive a lump sum of money; instead, an hourly payment arrangement is required. The hourly rate must match the type of care being provided and the experience level of the caregiver.

A family caregiving arrangement can work under the following circumstances:

  • The caregiver must be capable of the hard work involved
  • They must be properly contracted with hours logged and documented
  • Taxes on the compensation must be properly paid

If your family member treats caregiving like any other employer-employee relationship, the arrangement can be rewarding. But the record-keeping and documentation can be tricky, and mistakes can be very expensive.

To benefit from family caregiving without financial penalties, please contact our elder law attorneys for help. Our law firm is dedicated to keeping you informed of issues that affect seniors who may be experiencing declining health. We help you and your loved ones prepare for potential long-term medical expenses and the need to transition to in-home care, assisted living care, or nursing home care.

This article offers a summary of aspects of elder law. It is not legal advice and does not create an attorney-client relationship. For legal advice, contact our Ruston, LA office by calling us at (318) 255-1760.

A Nursing Home can be Covered by Medicaid

A Nursing Home can be Covered by Medicaid

Remember Medicaid planning doesn’t simply mean meeting strict income and asset limits to qualify for long-term care insurance. You will also need to demonstrate you need the level of care typically provided in a nursing home setting. These health eligibility rules are valid if you apply for nursing home coverage. Or a Medicaid waiver program for coverage in your home. Each state has a level of care requirement. And its own criteria to determine if you meet the mandated level of care. It can get complicated because eligibility criteria are not always clear.

Determining the level of care necessity usually includes:

  • The need for two or more activities of daily living constitutes bathing, toileting, dressing, eating, and mobility.
  • You require frequent medical care, like IVs or other injections, medications, or other medical treatment.
  • You exhibit behavioral problems such as aggressiveness or wandering away from home.
  • Alzheimer’s disease or another form of dementia impairs your cognitive ability. Making decisions on your own is problematic and/or you cannot correctly process information.

The state evaluates the assessment of a Medicaid applicant and, in many cases, will require a doctor’s diagnosis. The assessment generally requires the applicant to answer a series of questions about their abilities to perform activities of daily living and any behavioral issues or cognitive problems. There are further questions regarding the applicant’s family and their ability to provide support.

Understanding Medical Services Covered by Medicare

Medicare still covers the medical services you may need beyond nursing care along with institutional Medicaid. If you need to see a specialist or go to a doctor’s office, Medicare pays first, and Medicaid will cover your remaining costs like copayments, coinsurances, and deductibles. When applying for institutional Medicaid, consider the following:

  • The program considers you and your spouse together when counting assets and income. Typically, you can set aside a certain amount of assets and income to protect your spouse’s standard of living. This spousal amount does not count when applying for Medicaid.
  • You will still be able to keep a small amount of income for your allowance even though you qualify. The amount varies by state, and your local Medicaid office can provide more information. The remainder of your income will pay the nursing home.
  • There is a look-back period of up to five years for institutional Medicaid in most states. When determining your eligibility, your state will count any assets you have transferred in the past five years. If Medicaid determines any transfers violate the Medicaid eligibility rules, you may be penalized. Medicaid may opt to pay only a portion of your nursing home stay or none at all.
  • Owning your own home affects Medicaid eligibility and coverage. An elder law attorney can characterize your specific circumstances and how the equity in your home may count as an asset. When long-term care is no longer necessary, or you are deceased, these assets may repay Medicaid for your care coverage.

Nursing Home and Assisted Living

Nursing home level of care, also known as nursing facility level of care (NFLOC), Is not an easily definable term as there is no formal federal definition. Each state has the task of defining the term, and rules are not always consistent from one state to the other. Generally, there are four areas of concern, though not every state considers all four; physical functional ability, medical needs/health issues, cognitive impairment, and behavioral problems.

For those families with a loved one who requires more care than they can provide at home but do not require a high enough level of care to qualify for nursing home admittance, there is an in-between care type typically provided in assisted living. However, Medicaid coverage of this type of assisted living is very limited in numbers.

Nursing homes are experiencing very limited capacity, and waitlists can be years. Medicaid is adapting to provide this coverage type in-home to those applicants who may meet NFLOC Medicaid eligibility requirements but not pose a danger to themselves or others in a home environment. Perhaps using this as a springboard as a potential nursing home residence is waitlisted for full-time care.

Getting Informed

Before applying to become eligible for Medicaid nursing home coverage, there is much to consider. Applications that are insufficient or incorrectly filed can create delays, and with limited space available, it can be several years on a waiting list before admittance can take place.

The need is more significant than ever before for long-term care in a nursing home. Meeting your state’s eligibility requirements can be a long and complex series of providing documents, answering questionnaires, having assessments and reviews, and filling out and filing forms. The scope of the project can be overwhelming. To get to your best outcome, don’t wait. Contact our Ruston, LA office today at (318) 255-1760. Proactive planning with an elder law attorney will help you understand and address all criteria you need to act on to succeed.

 

The Importance of Hiring an Elder Law Attorney as Soon as Possible

The Importance of Hiring an Elder Law Attorney

Whether your loved ones are older adults, or you are concerned about your future health and financial well-being, an elder law attorney can help. Elder law is a highly specialized area of law focusing on the legal needs of older adults encompassing more significant issues like long-term health care needs, quality of life, and financial well-being. Know the importance of hiring an Elder Law attorney as soon as possible. Planning may include estate planning and administration, asset protection planning, Medicaid planning and applications, wills and trusts, probate, advance directives, special needs planning, and guardianships.

How would you answer the following questions:

  • Do you have a will, and has it been updated in the last five years?
  • Are your assets protected in the event you require home care or nursing home care?
  • Do you have a living will, including a health care proxy and durable power of attorney?
  • Is your home protected, perhaps in a trust?
  • Are you willing to spend half or even all of your assets on the cost of your elder care?

If your answers are no to any of these questions, it is time to consult with an elder law attorney.

The Importance of Medicaid Planning with an Elder Law Attorney

As you age, early planning is the key to enjoy a successful, secure, and less stressful lifestyle. Currently, the look-back period for Medicaid nursing home benefit qualifications is five years, and it is 2.5 years for Medicaid home care benefits. Early planning can protect many of your assets and still secure eligibility for government benefits.

The truth is, regardless of your age or wealth, you should have an estate plan. Your will sets forth instructions regarding which heirs will receive your property upon your death, name a guardian(s) for minor children, and protect assets in a special needs trust benefiting any disabled loved ones.  An estate plan will tackle tax planning, power of attorney, health care proxy, and a living will in the event of unforeseen incapacity.

Engaging in Medicaid planning and asset protection can ensure you or your loved one will receive the care they need and afford it. Medicaid planning can protect a healthy spouse who wishes to remain in your home with the financial resources to do so. Proper planning for Medicaid benefits can protect your assets from Medicaid’s estate recovery program, genuine estate liens.

How an Elder Care Attorney Can Help You or a Loved One?

Hiring an experienced elder care attorney can be the most significant financial safeguard a person can make. For their life or the life of a loved one. Specific services of an elder care attorney include but are not limited to:

  • Planning and managing of long-term care services – Your elder law attorney will compile financial information, insurance, and assets, including medical and housing needs, in addition to evaluating and implementing estate planning. Geriatric care, veterans benefits, financial and tax planning, and preparation are part of the process.
  • Planning and qualifying for Medicaid eligibility – Elder law attorneys understand the differences between Medicare and Medicaid. They can show how income levels and current asset holdings may affect your future benefits.
  • Interdictions (Guardianships) – In this process, a judge will appoint a person to manage another’s financial affairs known as a Curator (guardian). Particularly for those who can no longer care for themselves or have Alzheimer’s or other forms of dementia. Elder law attorneys can guide a family through the process of obtaining guardianship for their loved one’s benefit.
  • Administration of the estate, probate and trust(s) – This service benefits the estate holder and the designated trustees or executors. An elder law attorney can outline the rights and responsibilities of those with fiduciary appointments.
  • Estate and disability planning and preparedness – Many seniors have questions regarding the impact of their will on their family. And other tax and legal issues. Your elder law attorney can explain these impacts and help guide choices that ensure your legacy and benefit your heirs.

Getting the Guidance you Need

A well-crafted estate plan is invaluable to you and your beneficiaries. Your elder law attorney will help guide you through the estate plan process. Customizing it to meet your needs, and prepare the legal documents reflecting the laws of your state. Early proactive planning will yield the best results to protect your assets and your well-being. Contact our Ruston, LA office by calling us at (318) 255-1760 to establish or review your existing estate plan.

 

Medicaid Planning and the Dangers of Gift-Giving

If someone may need Medicaid assistance soon, giving gifts could have costly consequences. Medicaid is the government program that covers the huge expense of long-term care, for those who are not able to pay for it out of their own pocket. But to be eligible, Medicaid applicants must be pretty much broke. They are permitted to own no more than around $2,000.00. 

On the filing of a Medicaid application, caseworkers will meticulously investigate the applicant’s financial history. They are looking to see whether an applicant has given away money or assets over a period of years before the Medicaid application is filed. That period of years is known as the “look-back” period. In all states except California, that period for nursing-home care is five years under the current rules. In California the period is 2.5 years.

Depending on the size and number of gifts given away during the “look-back” period, the penalty imposed as a result could be substantial.

Many think that there would be no penalty for gifts of up to around $15,000 annually. That misunderstanding confuses tax law with Medicaid law (and it also is not quite accurate under tax law, but that’s another subject). In the Medicaid context, gifts of any amount that are given during the look-back period can be penalized.

There are a number of options to protect assets and still qualify for Medicaid. For instance, exceptions include gifts to spouses and siblings under certain circumstances, disabled children, and children who are caregivers and who live at home with the elder for a span of time. But overall, gifts and Medicaid do not go together. 

The Medicaid rules are complicated and the consequences for mistakes like gift-giving can be very costly. This is why it’s best to consult attorneys like us, who are especially qualified by our experience and expertise in Medicaid law. Please contact our Ruston, LA office by calling us at (318) 255-1760 or schedule an appointment to discuss how we can help with your Medicaid planning needs.

Don’t Wait to Start Medicaid Crisis Planning

A joint federal and state program, Medicaid is available to those who meet particular asset requirements that help them pay for long-term care (LTC) costs. Long-term care often creates devastating financial impacts on Americans, particularly the elderly, and for those family members who lose hours of income (and more) while providing care for their loved ones. The Medicaid system is still one of the best options to afford long-term care. Medicaid crisis planning is a strategy that can help you qualify for Medicaid without experiencing financial ruin.

As a joint federal and state social safety net Medicaid differs by eligibility rules and regulations in every state, and even by name. Unfortunately, people often wait until a catastrophic event brings about sudden illness, disability, or other medical crises before planning long-term care. Under duress, a family system will listen and take advice from misinformed individuals, such as non-attorneys or attorneys who do not practice elder law. Perhaps unwittingly, these people tend to give the worst advice: spend everything you have until you qualify under the Medicaid eligibility rules. Though this approach can work, there are far better strategies that can be employed. 

With the help of an elder law attorney, Medicaid crisis planning allows you to qualify for Medicaid nursing home/LTC without spending down all of your life’s assets. Working with an elder law attorney to devise a personal Medicaid crisis plan is a logical and financially prudent approach to long-term care and allows you or a loved one to use legally approved strategies to qualify for Medicaid before spending everything you own on the high cost of nursing home care.

If you have a loved one who is either in a nursing home or about to enter a nursing home, that is the time to speak to an elder law attorney. There are legal strategies that allow a person who needs long-term care to divest themselves of some of their assets, and use the rest to pay for their care until Medicaid eligibility is met.  The sooner an elder law attorney is employed, the quicker Medicaid eligibility can be met.  However, it’s never too late, even if you or a loved one are already in a nursing home.  

The level of complexity involved in Medicaid crisis planning deems it necessary to retain an elder law attorney, preferably one specializing in Medicaid planning. Eligibility requirements vary, calculations are complex, timing is crucial, forms are ever-changing, and laws are amended. An elder law attorney can tailor your financial situation to the best Medicaid crisis planning solution and protect your financial future.

In Sickness and Health: Protect Your Assets While Caring for Your Spouse

When people marry for the second time, losing assets to pay for their new spouse’s serious illness is probably the last thing they want to think about when they say “I do.” Current costs for long-term care facilities can run between $70,000 – $150,000 annually. Studies show that 70% of Americans will need that kind of care, perhaps for three years or longer.

If one spouse in a marriage becomes ill, the assets of both spouses are, by and large, required to be spent on the ill spouse’s care before Medicaid benefits become available. This could be a big problem, especially if money that the well spouse had saved for her children’s inheritances goes to pay for the ill new spouse’s care instead.

With careful planning, this need not happen. Financial arrangements can be made to protect the estate of the well spouse and to ensure that the spouse who needs care will be responsible to pay his or her own way.

The benefits rules do provide that the spouse who does not need care yet may keep an allowance of a certain sum for that spouse’s benefit. This is known as the “Community Spouse Resource Allowance” (CSRA). But many find that the CSRA is too small to permit the well spouse to maintain her standard of living, pay for her retirement, and still leave enough for her children to inherit.

Any planning or shifting of assets must be done very carefully and only after consulting with experienced professionals like us. The Medicaid rules heavily penalize transfers of assets made without receiving value in return. Gifts, in other words.

Assets can be protected, though, by a number of strategies that are permitted by the Medicaid rules. Some or all of the well spouse’s assets could buy a Medicaid-compliant annuity. This would provide an income stream for the well spouse, without the assets being otherwise deemed available to pay for the ill spouse’s care.

In turn, the assets of the spouse needing care could be transferred to people whom that person especially trusts: a trustee, or an agent for financial affairs, or a family member or beneficiary. That kind of transfer would be subject to penalty, but planned-for, using the strategies permitted under the Medicaid rules. Some relief from penalties can be achieved using existing Medicaid rules.

There are also insurance products available to provide for long-term care coverage, which any newly married couple – or everybody, really – ought to consider. Find advice on the various insurance options here.

The best strategy of all, though, is to consult an experienced elder law attorney as soon as possible. The sooner the consult, the more options are available and the more money can be saved.

When we embark on the adventure of marriage, nobody can tell what the future has in store. But with thoughtful planning, assisted by qualified elder law attorneys like us, you can relax and let the nuptial celebrations begin. Please contact our Ruston, LA office by calling us at (318) 255-1760 or schedule an appointment to discuss how we can help with your long-term care needs.

What an Elder Law Attorneys Do For You or a Loved One

According to the US Census Bureau, more than 51 million Americans are currently aged 65 or older, and the number is steadily increasing while medical and technological advancements are allowing seniors to live longer and better lives than ever before. The expanding needs of the US aging population are contributing to an increase in federal government senior assistance program complexity and availability. Every senior has a unique set of circumstances that set parameters to navigate a successful aging plan, and the best way to determine what your plan should be is to retain the counsel of an elder law attorney.

How can an elder law attorney assist you? An elder law attorney provides overarching coordination for the financial, legal, and health care decisions that seniors face. Finding and paying for long term care is something that many seniors and their family members fail to plan for, which can result in running out of money or not being able to secure appropriate care. Seniors or their families should seek legal assistance well before there is a need for long-term care of a loved one to plan for what type of long term care is desired and how it will be paid for. While an elder law attorney cannot be a specialist in all facets of a seniors plan for aging, they work in conjunction with other specialists when specific expertise is required.

Elder law attorneys can facilitate the establishment of a medical power of attorney, advanced health care directives in the case of dementia, or aiding in the selection process of the right long-term care facility and assisting in structuring the financial resources that cover the cost of that care. Those resources may include maintaining eligibility for Medicaid or Veterans’ benefits while protecting the senior’s assets for themselves and their legacy.

Elder law attorneys often assist with guardianships if a senior is no longer capable of making responsible and informed decisions regarding their health, living, and financial affairs, and no one has been designated to do so. Guardianships are normally a last resort, as they are costly, require court involvement for the lifetime of the incapacitated person, and a stranger could be appointed to oversee the incapacitated person’s finances. Ideally, a senior will have proper legal documents in place to avoid a guardianship, but unfortunately, this isn’t always the case.

A properly drafted estate or long term care plan can help avoid a guardianship, as the estate planning documents make sure there are proper agents named to handle financial and medical decisions in the event you or a loved one can no longer make those decisions. A properly drafted estate or long term care plan will also address how long term care will be paid for, and whether assistance with government benefits is necessary.

Identifying the right elder law attorney is essential for a senior, their future, and the future of their legacy. Typical questions to consider include: how long the attorney has specifically practiced elder law, if they have a particular specialty such as veteran’s benefits, Medicaid, estate planning, or probate expertise. You should also seek an elder law attorney whose practice is dedicated to elder law as this area of law is often changing and it is important to have an attorney who is on top of the latest rule changes.

Selecting the right elder law attorney for your personal needs or those of a loved one will make a significant impact on your plan for successful aging. Start well in advance of the time you or your family anticipates the need for your long-term care. If we can help you or a loved one with your elder law needs. Please contact our office by calling us at (318) 255-1760 and schedule an appointment to discuss how we can help.